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Alcoholic liver disease

Introduction

[Original article on NHS Choices website]

Alcoholic liver disease refers to liver damage caused by alcohol misuse. It covers a range of conditions and associated symptoms.

Alcoholic liver disease does not usually cause any symptoms until the liver has been extensively damaged. When this happens, symptoms can include:

nausea
weight loss
loss of appetite
yellowing of the eyes and skin (jaundice)
swelling in the ankles and abdomen
confusion or drowsiness

This often means that alcoholic liver disease is diagnosed during tests for other conditions that show that the liver has been damaged.

Read more about the symptoms of alcoholic liver disease.

If you have a history of regular alcohol misuse it is recommended that you contact your GP and ask for a liver function test.

Alcohol and the liver

With the exception of the brain, the liver is the most complex organ in the body.

The functions of the liver include:

filtering toxins from the blood
regulating cholesterol levels in the blood
helping to fight infection and disease

The liver is very resilient and is capable of regenerating itself. Each time your liver filters alcohol, some of the liver cells die. The liver can develop new cells, but prolonged alcohol misuse over many years can seriously damage the liver and is the cause of alcoholic liver disease.

Stages of alcoholic liver disease

There are three main stages of alcoholic liver disease, although there is often an overlap between each stage. The three stages are explained below.

Alcoholic fatty liver disease

Alcoholic fatty liver disease is the first stage of alcoholic liver disease.

Drinking a large amount of alcohol, even for only a few days, can lead to a build-up of fatty acids in the liver.

Fatty liver disease rarely causes any symptoms but it is an important warning sign that you are drinking at a level that is harmful to your health.

Fatty liver disease is reversible. If you stop drinking alcohol for two weeks, your liver should return to normal.

Alcoholic hepatitis

Alcoholic hepatitis (not related to infectious hepatitis) is the second, more serious stage of alcoholic liver disease.

Prolonged alcohol misuse over many years can cause the tissues of the liver to become inflamed. This is known as alcoholic hepatitis. Less commonly, alcoholic hepatitis can occur if you drink a large amount of alcohol in a short period of time (binge drinking).

Alcoholic hepatitis is usually reversible, although you may need to stop drinking alcohol for several months or years.

Cirrhosis

Cirrhosis is the final stage of alcoholic liver disease. Cirrhosis happens when prolonged inflammation causes scarring of the liver and loss of function. Loss of liver function can be life threatening.

The damage caused by cirrhosis is not reversible. In mild to moderate cases, stopping drinking alcohol immediately should prevent further damage and lead to the gradual recovery of liver function. In more severe cases, a liver transplant may be required.

Read more about living with alcoholic liver disease.

Can alcoholic liver disease be treated?

The treatment options for alcoholic liver disease largely depend on whether you stop drinking alcohol and make changes to your lifestyle, preferably for the rest of your life.

Treatment includes stopping drinking alcohol, nutritional therapy, medication and, in the most serious of cases, a liver transplant.

In the early stage of alcoholic liver disease (fatty liver and hepatitis), people who stop drinking have a good chance of their liver repairing itself.

In the most serious cases of cirrhosis you will only be considered for a liver transplant if you do not drink alcohol for at least three months.

How common is alcoholic liver disease?

Alcoholic liver disease is widespread in England.

It is estimated that:

90-100% of heavy drinkers have alcoholic fatty liver disease
one in four drinkers with fatty liver disease will develop alcoholic hepatitis
one in five drinkers with fatty liver disease will develop cirrhosis

A heavy drinker is someone who regularly drinks more than the recommended weekly limit for alcohol consumption. This is 3-4 units of alcohol a day for men and 2-3 units for women. Sticking to the recommended daily limit of alcohol units is the best way of preventing alcoholic liver disease.

Death rates linked to alcoholic liver disease have risen by more than two-thirds (69%) in the past 30 years. This makes alcohol one of the most common causes of death, along with smoking and high blood pressure.